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Sleep Apnea in Children


by Dr. Raymond Tan Suan-Kuo

Sleep apnea, generally considered a problem among middle-aged men, can be a problem for youngsters, too. The third Malaysian National Health and Morbidity Survey 2006 tells us that 20% of Malaysian children are obese. With the increasing rates of obesity in children, it is likely there will also be an increase in sleep apnea. It is estimated that 5 to 10% of Malaysian children suffer from sleep apnea.


Sleep apnea is characterised by brief but numerous involuntary breathing pauses during sleep. These breathing pauses cause awakenings throughout the night, making it impossible for sleep apnea sufferers to enjoy a night of deep, restorative sleep.



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Sleepy Day

People with sleep apnea often feel sleepy during the day and their concentration and daytime performance suffer. While being overweight or obese are risk factors for sleep apnea, being thin does not preclude a diagnosis.

The repercussions of sleep apnea and poor sleep for children are vast. When children do not get the sleep they need, they are at risk for health, performance, and safety problems; difficulties in school are often the result. However, sleep deprivation in children is often overlooked or attributed to attention-deficit or behaviour disorders.


Aware of Symptoms

Parents should be aware of night time and daytime symptoms of sleep apnea.

Night time symptoms include snoring, breathing pauses during sleep, restless sleep, mouth breathing, difficulty getting up in the morning, even after getting the proper amount of sleep.

Daytime symptoms include hyperactivity, inattention, behaviour problems, e.g. aggressive behaviour, problems at school, sleepiness and headaches.


Good Night Tips

To help your child get a good night's sleep, follow these tips :

*Establish a regular bedtime and wake up time. Parents and children should plan a daily schedule that includes the basic daily sleep requirements for particular age groups. This schedule should be maintained on the weekends, though students can be permitted to sleep in one or 2 hours on weekend mornings if necessary.


While individual sleep needs can vary, the amount of sleep suggested by sleep experts for particular age groups is:

18 months to 3 years : 12-14 hours
3 to 5 years : 11-13 hours
5 to 12 years : 10-11 hours
Teens : 9.25 hours

* Create a bedtime routine. Bedtime routines are important, regardless of a child's age. It should include at least 15 to 30 minutes of calm, soothing activities. Discourage television, exercise, computer and telephone use, and avoid caffeine (found in beverages, chocolate and other products).

* Achieve a balanced schedule. Identify and prioritise activities that allow for downtime and sufficient sleep time. Help students avoid an overloaded schedule that can lead to stress and difficulty coping, which contribute to poor health and sleep problems.


Healthy Body Weight Tips

To help children maintain a healthy body weight, follow these tips :

* Be supportive. Children know if they are overweight and don't need to be reminded or singled out.

* Plan family activities that involve exercise. Instead of watching TV, go hiking or biking, wash the car, or walk around the mall. Offer choices and let your children decide.

* Eat meals together as a family and eat at the table, not in front of the television. Eat slowly and enjoy the food.

* Don't use food as a reward or punishment. Children should not be placed on restrictive diets unless done so by a doctor (for medical reasons). Children need food for growth, development and energy.


Diagnose

# Seek treatment from an ENT specialist

# Look for large tonsils and adenoids

# Child may have an 'adenoids face' – a long face with flat cheeks, open-mouthed look with thick lower-lips, caused by years of mouthy breathing and little air entering the maxillary (cheeks) sinuses.

# Look for high blood pressure

# Look for poor growth (failure to thrive) and also, paradoxically, obesity

# Look for heart problems, e.g. heart failure and lung problems

# May need a sleep study

Treatment

1. Main treatment in children is surgery - remove the enlarged tonsils and adenoids

2. Lose weight – help children maintain a healthy body weight

3. Nasal steroid sprays for nasal allergies


4. CPAP (Continuous Positive Airway Pressure) mask at night for children who still have OSA and are very symptomatic after surgery.

Other High Risk Children

* Down’s Syndrome

* Children with craniofacial abnormalities e.g. Pierre Robin sequence, Treacher Collins Syndrome, Crouzon Syndrome.


More info on SLEEP APNEA here.






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Rawatan dan Langkah Pencegahan Tibi


oleh Bintu Rasyada A. Rahman

Pelbagai cara telah dilakukan. Langkah pencegahan juga telah dilaksanakan. Namun, penularan penyakit tibi (tuberculosis) tetap tidak ada surutnya. Malah angkanya terus meningkat dari tahun ke tahun.

Statistik WHO

Menurut statistik Pertubuhan Kesihatan Sedunia (WHO), hari ini terdapat lebih kurang 20 juta kes tibi aktif di seluruh dunia. Penyakit ini dikatakan menjangkiti antara 50 hingga 100 juta penghuni dunia terutama kanak-kanak secara tahunan.

3 juta kematian berlaku setiap tahun disebabkan penyakit jangkitan tibi dan 80% daripadanya melibatkan negara-negara membangun. WHO juga menyatakan hampir 26% kematian di negara dunia ketiga boleh dielakkan sekiranya pesakit tibi mendapatkan rawatan sewajarnya.

Apakah punca utama penyakit yang sudah wujud sejak zaman kuno ini terus bertahan? Bagaimana pula peranan kita dalam usaha untuk memastikan penyakit ini tidak lagi menjadi antara pembunuh utama penyakit berjangkit ini?


Senario Jangkitan Tibi di Malaysia

Di negara ini, angka mereka yang dijangkiti penyakit ini semakin meningkat dari tahun ke tahun.

Sejak 1989 secara purata sebanyak 11,500 hingga 12,000 kes dikesan setiap tahun. Separuh daripada kes ini didapati positif dijangkiti tibi. Pada 2006, seramai 14,000 pesakit tibi telah dapat dikesan yang mana nisbah jangkitan adalah 61 untuk setiap 100,000 penduduk.

Tahun berikutnya, sebanyak 16,000 kes baru dicatatkan dan pada 2008 pula sebanyak 17,506 kes baru didaftarkan. Daripada angka ini, 10,441 disahkan dijangkiti kuman tibi dengan 2207 kes melibatkan pendatang asing.

Angka jangkitan terus meningkat tahun lalu dengan 17,496 kes baru direkodkan.

Bagaimanapun, kes tibi di Malaysia masih rendah berbanding Filipina, Thailand dan Indonesia, namun lebih tinggi dari negara Singapura.


Tibi dan Pendatang Asing

Kemasukan pekerja dari negara-negara dunia ketiga sememangnya menjadi punca utama jangkitan tibi masih berleluasa biar pun tahap kebersihan dan kesihatan di negara ini boleh dikatakan berada pada paras sederhana.

Sememangnya sangat sinonim dengan negara mundur dan kemasukan pekerja dari negara-negara ini turut membawa sekali penyakit tersebut. Penyebaran kuman di kalangan pendatang berlaku dengan mudah disebabkan keadaan persekitaran yang memudahkan penyakit merebak dan menular.

Boleh dikatakan dengan keadaan tempat tinggal yang sempit dan kurang ventilasi menjadi salah satu sebab penting kepada jangkitan ini menular dengan mudah.

Negara maju seperti Amerika Syarikat juga turut berdepan dengan masalah ini disebabkan kemasukan pendatang asing dari negara membangun seperti Mexico.


Rawatan

Bakteria tibi mempunyai dinding sel yang tebal dan amat sukar untuk dibunuh menggunakan antibiotik. Kuman ini juga boleh hidup di dalam sel-sel darah dan di dalam tisu anggota badan lain.

Oleh itu, rawatan tibi perlu terus diberikan selama 6 bulan supaya semua kuman di dalam dan di luar sel dapat dibunuh sepenuhnya.

Cara rawatan adalah dengan memberikan antibiotik kepada pesakit. Ini adalah untuk mengelakkan kuman tibi menjadi kebal kepada ubat (multidrug resistance tibi). Ubat yang biasa diberi adalah isoniazid, rifampicin, pyrazinamide, streptomycin dan ethambutol. Pesakit perlu mengambil ubat-ubat ini setiap hari bagi 2 bulan pertama, sehinggalah pemeriksaan doktor dijalankan.

Sekiranya pemeriksaan doktor menunjukkan kemajuan dari segi simptom, imej imbasan sinar-X dan pemeriksaan kahak, cara pengambilan ubat akan diubah kepada 2 kali seminggu untuk 4 bulan seterusnya. Imbasan sinar-X dan ujian kahak perlulah dijalankan setiap 2 bulan sepanjang tempoh rawatan, sehinggalah pesakit didapati sembuh sepenuhnya (selalunya hanya dalam tempoh 6 bulan).

Seperti antibiotik lain, ubat-ubat untuk tibi juga mempunyai kesan sampingan termasuk loya, muntah, rasa gatal badan dan letih. Adalah sangat penting pesakit memaklumkan doktor atau jururawat jika terjadi sebarang kesan sampingan yang teruk.

Kejadian kuman tibi yang kebal kini didapati meningkat di beberapa negara di rantau Asia. Kuman jenis ini amat sukar dihapuskan dan kadar kematian pesakit akibat jangkitan kuman tibi kebal adalah setinggi 80%.


Langkah Pencegahan

Menurut kajian, pesakit yang aktif tibi akan menjangkiti 10 hingga 15 orang di sekelilingnya.

Bagi pesakit yang disahkan tibi mereka perlu :

* Mematuhi arahan pengambilan ubat yang telah ditetapkan tempohnya.

* Ambil cuti dan tidak ke tempat kerja atau sekolah bagi mengelakkan kuman tibi tersebar.

* Selepas beberapa minggu rawatan, pesakit akan rasa lebih baik dan tidak akan menjangkiti orang lain lagi. Doktor akan menasihatkan waktu yang paling sesuai untuk kembali berkerja atau ke sekolah.

* Asingkan bilik tidur, jangan berkongsi pakaian, makanan dan sebagainya. Elakkan sentuhan dengan orang lain bagi mengurangkan risiko jangkitan.

* Dari segi ventilasi, pastikan sistem pengudaran rumah dan pejabat dalam keadaan baik. Halakan kipas ke arah tingkap untuk meniup angin keluar dari ruang bilik. Ini akan mengurangkan peluang bakteria tibi untuk terus berada dalam ruang dan menjangkiti orang lain.

Selain itu, kanak-kanak yang merupakan golongan mudah dijangkiti digalakkan tidak mengunjungi hospital bagi mengelakkan penyebaran kuman tibi. Bagi bayi baru lahir, suntikan BCG mampu memberi perlindungan daripada bakteria tibi.

Pemeriksaan kesihatan menyeluruh perlu dilakukan ke atas pekerja yang masuk ke negara ini terutama jika dari negara dunia ketiga.


Lagi info tentang TIBI di sini.






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Sex During Pregnancy


by Dr. Milton Lum

It is common for women who are pregnant for the first time, to wonder whether sexual intercourse will affect the developing foetus.

The common questions include whether sexual intercourse will harm the foetus or cause infection and whether it can lead to miscarriage or premature labour. Another common question in the last trimester of pregnancy is what position to use and if any position is safer than others.




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Bodily Changes

There are many bodily changes in pregnancy that affects a woman's sex life.

Some women feel sexier. Others are not in the mood, especially when they have nausea and vomiting in the first trimester. Some women report an increase in libido in the second trimester. When the third trimester comes along, many women report a decrease in libido.

The variation in feelings and experiences are normal. It is important to remember that there is no norm. The feelings and experiences may also vary in the same woman in different pregnancies.


Sex Feeling Changes

There is an increase in the blood flow to the reproductive organs during pregnancy, causing them to engorge. This increases sensation in some women but is uncomfortable in other women, to the extent that sexual intercourse may be painful.

An orgasm can cause an increase in uterine activity with contractions felt especially in the third trimester. The contractions last a few minutes and then go away, just like the Braxton Hicks contractions.

There may also be changes in the spouse or partner. His interest may wane in the third trimester because of a variety of reasons. It may be because of concern about the health of the pregnant woman and/or fear of harming the pregnant woman and/or the foetus. There may also be anxiety about impending parenthood.

Normal Pregnancy

The developing foetus lies in a fluid-filled sac within the uterus. The sac and the uterine muscles protect the foetus from harm. There is a plug of mucus in the cervix that prevents infection from ascending from the vagina into the uterus.

Orgasm may cause some uterine activity which, however, does not harm the foetus. This increased uterine activity is not the same as the contractions that one gets in early labour. So it is safe for women with a normal pregnancy to have sexual intercourse during pregnancy even right up to the time when labour starts.


Miscarriage and Premature Labour

There is no relationship between sexual intercourse and miscarriage and premature labour in women with a normal pregnancy. In fact, there are reports that women who had regular sex during pregnancy were less likely to go into premature labour.

Sex during pregnancy may also enhance the relationship with the spouse or partner during the pregnancy and after childbirth.

It is important to confirm with the doctor on a regular basis that there are no pregnancy problems and that the pregnancy is normal.

No Intercourse

There are certain conditions which, if present, would result in the doctor advising to refrain from sexual intercourse.

The doctor should be consulted without delay if there is bleeding and/or pain during pregnancy, whether associated with sexual intercourse or not. An obstetric examination and an ultrasound will usually be done to elucidate the cause of the bleeding and/or pain and reassure that the foetus is all right.

The placenta may sometimes lie on the cervix (placenta praevia). In such a situation, the doctor will advise refraining from vaginal intercourse altogether.

If there is recurrent bleeding and there is no placenta praevia, the doctor may advise a reduction in the frequency of sex. This does not mean that one cannot partake of other forms of sexual activity.

The risk of infection to the foetus is not increased if the man does not have a sexually transmitted infection. If he does, it should be treated and once cured, sexual intercourse can be resumed. However, if the man has herpes, it would be advisable to refrain from sexual intercourse. If a pregnant woman gets genital herpes for the first time, there is a small likelihood that the foetus would be infected.

The doctor would also advise the pregnant woman to refrain from sexual intercourse if there is leakage of the fluid in the sac (liquor) surrounding the foetus because of the risk of infection of the liquor and through it, the foetus, as well. If there is a history of weakness of the cervix, it would also be advisable to refrain from sexual intercourse.


Alternative Positions

As the abdomen increases in size with advancing pregnancy, the woman may be uncomfortable with the traditional man on top position. It is advisable to find alternative positions. By trying out various other positions, the couple will find one that they are both comfortable with.

It is safe to have sexual intercourse in a normal pregnancy. It is important to check with the doctor on a regular basis that there are no pregnancy problems.

The doctor may advise refraining from sexual intercourse when certain conditions are present. One would need to adapt as pregnancy advances.




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More info on SEX DURING PREGNANCY here.






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Anatomi Kulit


Kulit mempunyai 3 lapisan iaitu epidermis, dermis dan tisu subcutaneous yang berlemak.


Epidermis

Epidermis adalah lapisan paling atas yang nipis. Ketebalan epidermis berbeza-beza mengikut kedudukan dan taburannya pada tubuh kita. Misalnya epidermis pada tapak tangan dan kaki lebih tebal berbanding epidermis kulit pada badan. Yang paling nipis adalah epidermis pada kelopak mata. Epidermis terbentuk daripada beberapa lapisan dengan yang teratas sekali dipanggil stratun corneum.



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Stratum corneum dipenuhi sel-sel mati yang amat halus dan sukar dilihat oleh mata kasar. Sel-sel ini akan disingkirkan setiap hari. Ada kalanya ia banyak dan dilihat seperti kulit mengelupas. Bagi pengguna produk pengelupasan, apa yang disingkirkan adalah sel-sel epidermis ini. Proses pengelupasan haruslah mengikut prosedur dan sukatan yang betul. Andaikata bahan kimia yang digunakan adalah toksik dan boleh merosakkan sel. maka seluruh epidermis akan rosak dan tidak mampu dipulihkan sepenuhnya. Kulit akan tampak tidak sekata dan kehitaman disebabkan pigmentasi.

Lapisan kedua dikenali sebagai malphigian. Ia adalah lapisan sel-sel separuh matang yang mengeluarkan sel-sel bagi lapisan teratas. Sel melanocytes pula merupakan sel yang mengeluarkan warna kulit. Warna kulit yang gelap terhasil apabila kita berjemur di bawah matahari kerana sel melanocyte akan menjadi aktif apabila terkena pancaran matahari. Sebenarnya ini adalah proses pertahanan kulit kita terhadap ancaman matahari. Namun begitu sel melanocyte yang terlalu aktif akan menyebabkan kulit terlalu hitam atau pigmentasi. Bila ia kurang aktif kulit tampak keputihan seperti yang terjadi kepada pesakit sopak atau albino.


Dermis

Dermis mengandungi protein dipanggil kolagen yang memberikan keanjalan kulit. Ia merupakan satu tisu kompleks yang mengandungi salur darah, lymphatic, saraf, kelenjar, sel-sel rambut dan pelbagai sel lain yang berfungsi dengan unik bagi menstabilkan kulit.

Lapisan Lemak

Lapisan paling bawah adalah lelemak pada kulit. Lelemak ini penting bagi memberi kontur yang cantik pada wajah. Cuba lihat individu yang tiada lemak pada pipi. Pipinya kelihatan kecut dan tidak manis di pandang. Bak kata orang orang tua 'hidung tak mancung pipi pula tersorong-sorong'. Pepatah itu menunjukkan seseorang akan tampak tidak manis bila pipinya kecut.

Kalenjar

Kalenjar pada kulit pula terdapat tiga jenis iaitu :

* kalenjar apokrin yang taburannya pada kawasan berambut seperti ketiak dan genitalia. Ia mengeluarkan bau badan seseorang.

* kalenjar sebaceous yang mengeluarkan sebum dan pelincir tubuh. Taburannya pada seluruh tubuh kecuali pada tapak tangan dan kaki.

* kalenjar ekrin pula adalah kelenjar peluh yang berfungsi menseimbangkan garam dan air dalam badan kita.


Lagi info tentang KULIT di sini.






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Liver Cancer


by Dr S. Y. Chong

The liver plays an essential role in regulating life processes. Before birth, it serves as the main organ of blood formation. Thereafter, its primary functions are to refine and detoxify everything you eat, breathe, and absorb through your skin. The liver is a silent, faithful partner and does not complain UNTIL advanced damage has occurred.




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Primary Liver Cancer

Primary liver cancer is the fifth most common cancer in the world. Primary liver cancer refers to cancer that originates from the cells of the liver. This is different from metastatic liver cancer, which refers to the invasion of cancer cells from another organ such as the breast and lungs spreading to the liver.

Of the 600,000 new cases diagnosed annually worldwide, approximately 400,000 come from China, Japan, Taiwan, and South Korea combined. It is the sixth most common cancer in Malaysia, affecting more men than women, and occurring between the ages of 50 and 60.


Causes

The causes of liver cancer depend on many factors. A key step in the progression to liver cancer is scarring of the liver due to liver cell damage (cirrhosis). This scarring can be caused by hepatitis B or C infection, alcohol abuse, aflatoxins (a mould that grows on foods such as peanuts, rice, and wheat that has been stored in a hot and humid environment), as well as rare diseases that lead to chronic inflammation of the liver, such as Wilson’s disease or haemochromatosis.

Hepatitis B

In Asia, the key risk factor for liver cancer is chronic hepatitis B infection. It is spread mainly via blood, sexual contact, and between mother and foetus during pregnancy. Whilst the majority of people who have acute hepatitis B will overcome the infection, the virus can linger in about 10% of patients for up to 6 months. Such patients are known as hepatitis B carriers or have chronic hepatitis B infection, depending on levels of virus in the blood and liver enzyme levels.


As chronic hepatitis B infection will lead to liver cell damage and cirrhosis, it is essential to follow-up closely with these patients and provide appropriate antiviral treatment to them.

A hepatitis B vaccination programme has been in place in Malaysia since 1989 to prevent hepatitis B infection. It is also essential to vaccinate newborns as 90% of infections in this group will result in chronic infection. If you have a relative with hepatitis B or liver cancer, it is important to get yourself screened to determine your status.

Hepatitis C

For hepatitis C, major routes of transmission include administration of infected therapeutic blood products and intravenous drug abuse. However, all blood products are now routinely screened for the virus. There is no vaccine for hepatitis C.

Alcohol

Alcohol use or overuse may increase a person's chances of developing liver cancer. Approximately 15% of all alcoholics will develop cirrhosis. In carriers of the hepatitis B or C virus, alcohol consumption also greatly increases the risk of developing cancer. Patients with viral hepatitis are strongly advised to refrain from consuming alcohol.

Signs and Symptoms

Signs and symptoms of liver cancer tend to appear at later stages of the disease. These include abdominal pain on the right side (just under the right ribcage), weight loss, fatigue, easy bruising or bleeding, enlarged abdomen or yellow skin and eyes (jaundice). Physicians may be able to feel a lump in the abdomen upon examination.

In the diagnosis of liver cancer, a range of blood tests complement the observation of physical signs and symptoms. These include liver function tests that measure the level of various enzymes produced by the liver and other parameters such as albumin and bilirubin.

In liver cancer patients, liver enzyme levels as well as the liver-specific tumour marker, alpha-feto protein, is often abnormally high.


CT and MRI scans are also used to detect liver tumours. These scans help pick up on the presence of the vascular (blood-supply) pattern typical to liver cancer.

In cases where a tumour is under 2cm in size, a liver biopsy may be done to enable early confirmatory diagnosis. This involves extracting samples of tumour tissue with a fine-needle syringe under guidance of an ultrasound or CT scan. The samples are then sent to a histopathology laboratory to confirm diagnosis of primary liver cancer.

Treatment

Small tumours that are detected early can be successfully treated with surgery. This is the treatment of choice for patients with uncomplicated solitary tumours and if the cancer has not spread beyond the liver.


Liver transplant is another optimal therapeutic option for large and complicated lesions as it removes the entire tumour and underlying cirrhosis. However, the availability of donor organs is limited. Moreover, patients commonly present at a stage that is too late even for this option.

Locoregional Treatment

These are treatment options that damage or kill the tumour directly. They include :

Percutaneous ethanol injection

Involving the injection of pure alcohol into the tumour to destroy the tumour tissue, this treatment is used when the disease is locally advanced and the patient is not suitable for surgery. This approach is more effective in small tumours that are less than 3cm in diameter.

Radiofrequency ablation

For patients who have tumours between 2cm and 5cm in diameter and are not suitable for surgery, an effective treatment would be to destroy the tumour tissue through heat from electrodes inserted directly into the tumour.

Trans-arterial chemo-embolisation (TACE)

TACE is a type of chemotherapy that supplies strong anti-cancer drugs directly to the liver. Unlike the traditional systemic infusion of chemotherapy into the blood vessels, TACE has the advantage of confining high concentrations of the drug to the tumour, depriving it of its needed blood supply by blocking arterial supply to the tumour (embolisation), which in turn leads to the damage or death of the tumour cells.

TACE is suitable for patients with inoperable liver cancer where the tumour has not invaded the main blood vessel of the liver or spread beyond the liver.

Systemic therapies

Until recently, there has been a lack of effective systemic agents that increase the survival of patients with liver cancer. Systemic therapy may be oral or intravenous agents that are aimed at destroying cancer cells. However, these therapies affect the whole body. Conventional chemotherapy regimens have not been found to be particularly effective as response rates are low with no survival advantage.

Sorafenib


The increasing knowledge of the molecular processes involved in the progression of the liver tumour over more recent years has led to the development of targeted therapies. Currently, one such agent known as sorafenib has been approved in Malaysia for the treatment of patients with advanced liver cancer. Taken orally, sorafenib acts by preventing the generation of new blood vessels within the tumour, effectively slowing down or stopping tumour growth. It has been proven to extend the survival of selected patients with advanced, inoperable liver cancer.

Liver cancer is a complex disease with many causative factors. However, in Malaysia, hepatitis B is the single most important risk factor in the development of this disease and vaccination as well as surveillance programmes are vital in reducing the incidence of liver cancer.

Whilst there are a few treatment modalities, early detection is the best way to effectively treat and prolong survival. However, even in advanced liver disease, there is still hope with molecular targeted therapies and much research is still being done in this area.


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Masalah Kencing Tidak Lawas


Masalah kencing tidak lawas akibat pembesaran kelenjar prostat adalah lazim di kalangan lelaki berusia. Sebenarnya anda tidak keseorangan. Ini kerana pembesaran prostat boleh menjejaskan sehingga 50% kaum lelaki yang berusia 50 tahun dan ke atas. Semakin bertambah usia seseorang lelaki, maka semakin tinggi risiko untuk mendapat masalah seperti ini.

Adalah dicadangkan agar pemeriksaan doktor dibuat untuk memastikan kencing tidak lawas yang dialami sememangnya berpunca daripada pembesaran kelenjar prostat yang tidak bersifat kanser.

Amalan

Antara amalan yang boleh diamalkan untuk mengurangkan ketidakselesaan anda termasuklah :

* Hadkan pengambilan minuman waktu malam. Ini dapat membantu mengurangkan kekerapan keperluan ke bilik air pada waktu malam. Ini juga akan membantu mengurangkan gangguan tidur anda.


* Kurangkan jumlah penggunaan alkohol dan kafein. Alkohol, kopi, teh, coklat dan minuman ringan mempunyai kesan diuretik yang boleh menambahkan kekerapan buang air kecil.

* Gunakan setiap kesempatan untuk ke bilik air. Cuba kosongkan dengan sepenuhnya pundi kencing anda dan elakkan penundaan proses ini kerana ia akan meregangkan pundi kencing.

* Latihan pundi kencing. Amalan yang tetap dan teratur untuk buang air kecil akan membantu memperbaiki frekuensi dan keinginan kencing yang teruk.

Cuaca dingin atau berada dalam persekitaran sejuk akan meningkatkan frekuensi keinginan untuk kencing. Oleh yang demikian, mengelakkan berada dalam persekitaran sejuk sedikit sebanyak akan melegakan anda.


Makanan Tambahan

Makanan tambahan seperti saw palmetto telah lama digunakan oleh jutaan lelaki untuk meringankan gejala kencing akibat pembesaran prostat yang bukan bersifat kanser. Keberkesannya dipercayai kerana kebolehannya merencatkan penukaran testosteron menjadi dihidrotestosteron, hormon yang dikaitkan dengan pertumbuhan tisu prostat.

Di samping itu, biji labu juga telah lama digunakan kerana manfaatnya bagi kesihatan prostat. Biji labu yang kaya dengan asid lemak tidak tepu dan kandungan zink yang tinggi membantu kesihatan reproduksi lelaki. Kombinasi suplemen saw palmetto dan biji labu membawa manfaat dalam pengurusan kesihatan prostat.


Lagi info tentang KENCING TIDAK LAWAS di sini.






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When Kids Don't Want to Eat



by Dr. Norimah A. Karim

Your child’s growth is one of your primary concerns as parents. In fact, every parent in the world wants his or her child to grow up strong and healthy. It is understandable that you want your child to be the smartest, strongest, or the healthiest child in his class.


Hence, some parents may feel the need to frequently monitor their child's nutritional intake, which at times can lead to additional worry about the child's 'lack of appetite'. When he is eating less than his older sibling, you worry.

When he keeps playing with his food rather than eating it, you worry. When he prefers eating smaller meals, you worry.



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Stop Worrying!

More often than not, there is nothing wrong with your child. Just because he is not eating as much as you would have liked or expected does not mean that your child has a poor appetite. Nor does it mean that he will grow up stunted and malnourished.

As long as your child follows the recommended dietary guidelines and is healthy, you should not worry too much.

Is Your Child Eating a Balanced and Adequate Meal?

Good nutrition is essential for growing children. A growing child needs foods that fuel him with energy so that he can play, learn, and explore the world. However, good nutrition does not mean that your child has to eat as much as possible. Chances are, if you pile your child's plate high with food, he will not be able to finish it.

When this happens, do not take this as an indication of a feeding problem, but understand that every child is different and appetite may also vary considerably. Follow the 3 golden rules below to ensure that your child is well nourished :


1. Balance

Having too much or too little of a certain nutrient is never good as this may result in health problems. Avoid nutritional excesses or deficiencies by referring to the Food Guide Pyramid. Serve something from each level for each meal to give your child the nutritional balance he needs.

2. Moderation

Kids may sometimes enjoy foods that are often considered bad (like sweets). However, bear in mind that all foods can be part of healthy eating as long as they are taken in moderation.

The same applies to foods considered healthy. Eating too much of a good thing is not necessarily good, so teach your child how to enjoy their favourite foods in moderation.

3. Variety

No single food can meet all the nutritional needs of your child. The type and amount of nutrients available varies from food to food. So, give your child a variety of food for each meal to ensure that your child gets all the nutrients he needs daily.

That said, above all, quality is always more important than quantity. Your child will grow up just fine if he does not eat everything you put on his plate, as long he eats according to the recommended nutritional guidelines. His body is perfectly capable of telling him how much food he needs to regulate his growth.


Is Your Child Getting Enough?

So, how do you determine if your child is getting the appropriate amount of nutrients that he needs to support his growth?

The most simple and effective way to do so is by assessing your child's physical growth periodically. Monitor his height and body weight and use those measurements to calculate his Body Mass Index.

Note that an average child grows taller by 6cm to 8cm and 2kg to 3kg heavier annually. However, do remember that your child will grow at his own rate and comparisons with his peers or siblings may be futile.

How to Calculate BMI

Get your child's weight and height measurements and use the following formula to calculate his or her BMI :

BMI = weight (kg) / height (m) x height (m)

After you have calculated his BMI, use the growth charts that are based on the standards recommended by the World Health Organization (WHO) to determine if your child's growth is satisfactory. Take note that the growth charts are gender specific, so you need to use the appropriate chart for boys or girls.

If your child is growing right (based on the BMI calculation), you do not need to worry even if his eating habits are not to your liking.


Other Signs

Additionally, watch out for other signs that indicate that your child is getting the nourishment he needs :

* Your child achieves the appropriate developmental milestones

* Your child is mentally alert and is able to learn and play well

* Your child has sufficient energy (or more) to cope with his daily activities

* Your child is healthy and is in good physical shape

You can also take your child to the doctor for a complete assessment of his growth and development, if you prefer to get advice from the experts. Using the measurements taken during each visit, the doctor will be able to chart your child's growth patterns and alert you if any problems are detected.

Watching your child grow should be an experience that every parent enjoys. Thus, do not burden yourself with unnecessary worries about your child's eating habits. The key is to have your child eat right and monitor your child's growth.


More info on CHILDRENhere.






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Khasiat Tomato : Cantikkan Wajah/Kulit


Tomato atau nama saintifiknya Iycopersicon esculetum sememangnya digemari ramai. Sama ada diratah begitu sahaja atau digandingkan dalam pelbagai jenis masakan, tomato menjanjikan keenakan tersendiri. Hidangan Mediterranean dan Asia Barat menjadikan tomato sebagai bahan asas yang paling kerap digunakan.

Berasal dari keluarga Solanaceae, tomato kaya dengan zat besi, serat serta vitamin A dan C yang diperlukan untuk mengekalkan kecergasan badan. Ia juga mengandungi fruktosa, glukosa, asid folik, potasium, kalsium dan mineral garam.

Malah kajian di Amerika Syarikat mendapati pigmen merah pada kulit tomato mengandungi lycopene yang dikatakan mampu mengurangkan risiko barah prostat di kalangan kaum lelaki. Lycopene menawarkan khasiat antioksida semula jadi yang baik untuk kesihatan badan.

Khasiat tomato juga berkait rapat dengan kecantikan kulit. Sayuran ini dikatakan berkesan untuk mengecilkan liang roma, mengurangkan masalah jerawat dan merawat penyakit kulit. Elemen penyejuk juga mampu menyejukkan kulit yang kasar, astringen untuk menghapuskan minyak berlebihan, dan vitamin A dan C untuk mencerahkan kulit kusam dan mengembalikan keremajaan kulit.

Berikut adalah petua dan cara-cara penjagaan kulit menggunakan tomato.


Mengecilkan Liang Roma

Campurkan satu sudu jus tomato segar dengan 2 hingga 4 titik jus limau. Sapukan bahan tersebut menggunakan kapas pada kulit wajah dan urut perlahan-lahan. Biarkan selama 15 minit. Bilas dengan air suam untuk mengecilkan lagi liang roma, selepas itu sapukan pelembap muka.

Merawat Jerawat

Hancurkan tomato segar dan sapu rata bahan tersebut pada kulit muka yang berjerawat. Biarkan sejam atau lebih sebelum dibilas dan dikeringkan. Buat setiap hari sehingga jerawat hilang.

Membersihkan Kulit Muka

Topeng muka menggunakan campuran tomato dan avokado amat sesuai untuk kulit kombinasi (berminyak, biasa dan kering) kerana ia menggabungkan astringen dan antiseptik yang boleh mengurangkan kandungan minyak serta noda hitam pada kulit.

Topeng penyegar muka ini kaya dengan vitamin A, C dan E - kesemuanya penting untuk kulit yang sihat. Untuk membuat topeng muka ini, hancurkan tomato dan avokado dalam mangkuk dan sapukan pada muka, bilas selepas 20 ke 30 minit.


Boleh juga sapukan campurkan jus tomato segar dengan jus timun pada kulit muka untuk mengawal minyak and jerawat.

Menyejukkan Kulit Yang Rosak

Kisar sebiji tomato dan campurkan dua sudu yogurt. Sapu bahan tersebut pada kulit muka dan biarkan selama 20 minit. Bilas dengan air suam.

Gabungan tomato dan yogurt mampu menyejukkan kulit dan mengurangkan kesan kesakitan termasuk akibat selaran matahari dan kerengsaan kulit. Ini kerana yogurt merangsang protein pada kulit dan menjadikannya lembut manakala tomato menyejuk dan meneutralkan permukaan kulit.


Lagi info tentang TOMATO di sini.


Artikel berkaitan :

Khasiat Tomato








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Pregnancy Planning


by Dr. Nor Ashikin Mokhtar

Preparing for pregnancy lets you create a healthy and hospitable environment for the foetus-to-be and helps prevent problems such as birth defects. If a woman were to put as much care and thought into planning her pregnancy, she can contribute a lot towards ensuring the health and well-being of her baby, as well as eliminating many of the uncertainties that are present during pregnancy.


The state of your physical health before you conceive plays a huge role in determining whether you will conceive and carry through a healthy pregnancy.



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Who Needs a Pregnancy Planner?

Every woman of reproductive age is a potential mum and should be aware of her body and health even if she is not consciously planning to have a baby. It is good to practise prenatal care during pregnancy, but it is often the period before, and in the early stage of, conception that women forget about – and that is the most important time!

A baby is conceived about 2 weeks before a woman's period is due, which means that she most likely will not know that she is pregnant until she is more than 3 weeks into the pregnancy. Yet the little one is most vulnerable in the 2 to 8 weeks after conception, which is when the vital organs are beginning to develop. Any dangerous substances or injuries to your body at this point could cause irreversible damage.


That is why it is good to start acting pregnant before they actually are. It may sound silly to go through life pretending to be pregnant, but in actual fact, you are creating a healthy and hospitable environment for the foetus-to-be and preventing problems such as birth defects.

If you are consciously planning to have a baby, you can start discussing with your doctor any time, even as early as a year ahead. Your doctor or obstetrician will be able to evaluate your health and identify health and lifestyle risks that may affect your future pregnancy.

Pregnancy planning covers a whole range of lifestyle elements, including diet and nutrition, body weight, exercise, intake of medications and other substances, immunisations, and genetic testing.


Healthy Lifestyle Habits

Your lifestyle covers a range of behaviours and practices in your daily life – many of which you may take for granted and not give a second thought to. It is important to pause and look at the areas of your life that need to be changed.

Eating healthily, maintaining the right body weight, and exercising regularly will help you keep in good health for conception, and reduce problems for you and your baby during pregnancy. What you should and should not eat is so important.

Linked to good nutrition is your body weight, which you need to monitor before and during pregnancy. If you are underweight or overweight before you conceive, try to get to a healthier weight – which not only makes it easier for you to conceive, but also reduces stress on your body during pregnancy and lowers the risk of problems like high blood pressure or high glucose.

What other habits would you need to discard or change? Smoking, drinking alcohol and taking drugs can cause problems for the baby in the womb, and after it is born. Smoking can cause miscarriage, bleeding, premature birth, low birth weight, as well as slower physical and intellectual development.

Alcohol can cause foetal alcohol syndrome, which contributes to birth defects, including mental problems, slow growth and physical defects. Abuse of illegal drugs like marijuana and cocaine is not only risky for the mother, but also causes harm to the baby, such as miscarriage, premature birth, or even addiction to the child when he or she is born.

There are no shortcuts to this – you have to stop smoking, stop drinking alcohol, and be drug-free if you want to get pregnant. This will have to go on during pregnancy and during the breastfeeding period as well.


Getting the Right Shots

If you are planning to get pregnant, you should see your doctor and ask whether you may be at risk of any infectious diseases, such as rubella or chicken pox, that could cause serious harm to your unborn baby during pregnancy.

Rubella can cause your baby to be at increased risk for deafness, heart problems, cataracts of the eyes, and mental retardation. Chicken pox during pregnancy causes congenital varicella in the baby, including problems such as scarring of the skin, weakening or withering of the arms and legs, and eye abnormalities.

If you test negative for immunity against these diseases, it means that you have never developed them before and you require vaccinations before you conceive. You should wait at least one month after the vaccination before trying to get pregnant – and if you are already pregnant, you should not receive either of these vaccinations.

Other infectious diseases that you should be concerned with are hepatitis B and HIV. If you are a carrier of the hepatitis B virus, your baby can be protected with immunisation during delivery. If you have HIV, there are antiretroviral medications that will be given to you during pregnancy, labour, and delivery to reduce the risk of transmitting the virus to your baby.


Medications and Illnesses

You may rely on medications for certain health problems, or on supplements, but be aware that many of these compounds can be dangerous to a foetus during pregnancy.

Normal over-the-counter medicines like aspirin can cause defects in the baby, while prescription medications, such as for asthma, epilepsy, thyroid problems, migraines or acne, may also be harmful.

Even certain supplements containing herbs or vitamins and minerals can impact the foetus’ health during pregnancy. It is best to sit down with your doctor for a full review of the medications and supplements that you commonly take, when you are planning your pregnancy.

Needless to say, many women may be taking prescription medications to control chronic conditions, such as high blood pressure or diabetes. You should not stop the medications on your own, as these conditions can cause complications during pregnancy.

Hypertension can interfere with the growth of the unborn baby and increase the risk of foetal death, as well as preeclampsia. Uncontrolled diabetes can lead to miscarriage or birth defects. To keep these conditions well under control throughout pregnancy, your doctor should switch you over to safer medications before you conceive. For instance, oral diabetes medications should be replaced with insulin instead.

Genetic Testing

As medical technology improves every day, we know now more about diseases that run in the family, as well as other diseases that are linked to chromosomal abnormalities. Genetic testing and counselling can help you detect if you are at risk of, or carry these genetic traits.

Cystic fibrosis, Tay-Sachs, sickle cell anaemia, and certain neurological diseases are among the conditions that can be tested for genetic traits prior to pregnancy. If you are above 35 when you get pregnant, you may be at higher risk of having babies with chromosomal abnormalities, such as Down’s Syndrome. These conditions can also be detected through genetic analysis.

Part of the planning process is counselling to help prepare you and your spouse for the risks of these pregnancies.


Other Hazards

There are many other aspects of your daily life which you may have taken for granted, and which you will now have to be extra careful about, due to an impending pregnancy.

For instance, are you exposed to hazardous chemicals in your home or workplace? Stay away from strong-smelling cleansers, chemicals, paint, heavy metals like lead, copper and mercury, or materials that produce radiation, cardon disulphide, acids, and anaesthetic gases. If you do have to come into contact with them, reduce your risk by wearing rubber gloves, special equipment or working in a well-ventilated area.

Even cats can be a hazard! Cats’ faeces can contain a parasite that causes toxoplasmosis, which is harmful to an unborn baby. This parasite is also present in raw or undercooked meat, or dirt that has been contaminated by cat faeces.

While all the precautionary measures described above may sound insurmountable, it is a small price to pay for the health of your baby. Sometimes, all it takes are some small changes in your lifestyle or environment – it’s not too much to ask of anyone.


More info on PREGNANCY here.






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Pendarahan Saluran Gastrousus


oleh Dr. Tan Huck Joo

Adalah mudah untuk mengenal satu pukulan atau luka pada badan anda kerana anda dapat melihat darah mengalir keluar. Tetapi bagaimana anda tahu jika anda ada pendarahan dalaman? Jawapannya adalah dalam najis anda. Sebagai contoh, pesakit dengan pendarahan gastrousus aktif daripada perut atau duodenum umumnya akan mengeluarkan najis yang seakan-akan berwarna hitam. Pesakit yang berdarah dari usus besar akan mengeluar najis bercampur dengan darah.




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Tetapi apakah akan berlaku jika anda tidak boleh melihat darah? Dengan peralatan 'immonuchemical kit', ia akan membantu seseorang yang mengalami pendarahan dalaman atau najis hitam yang kita tak dapat melihat dengan mata kasar.

Apa Itu Pendarahan Gastrousus?

Saluran gastrousus (Gastrointestinal Bleeding - GI) kita adalah esofagus, perut, usus kecil, kolon, rektum, dan dubur. Pendarahan boleh dari mana-mana bahagian. Mengenali puncanya adalah langkah pertama untuk mengatasi perkara ini.


Dari Mana Pendarahan?

Pendarahan bahagian atas gastrosus

Esofagus, perut dan duodenum adalah dari bahagian atas. Jika anda berdarah dari bahagian ini, anda akan mengeluarkan najis yang berwarna hitam.

Ini menandakan darah dalam najis. Anda mungkin muntah darah yang berwarna merah menyala, darah beku yang berwarna gelap atau muntah seperti serbuk kopi. Walau bagaimanapun, jika anda mengalami pendarahan banyak dari bahagian atas saluran gastrousus, anda mungkin mengeluarkan darah yang berwarna merah menyala yang keluar dari dubur anda.

Pendarahan bahagian bawah GI

Usus besar, rektum, dan dubur adalah dari bahagian bawah gastrousus. Jika anda mengalami pendarahan dari bahagian bawah gastrousus, anda akan mengeluarkan darah yang berwarna merah menyala (darah baru) atau merah pulasan (darah lama).

Lagi jauh punca pendarahan dari dubur lebih gelap warna darahnya. Jika anda mengalami pendarahan dari sebelah kanan kolon iaitu sekum atau kolon menaik (ascending colon) atau kolon melintang (transverse colon), anda akan mengeluarkan najis berwarna merah menyala.

Bagaimana Doktor Mengesan Pendarahan?

Endoskopi - Kaedah ini digunakan untuk diagnosis dan merawat keadaan yang melibatkan esofagus, perut dan duodenum. Ia dilakukan dengan menguna kamera kecil pada hujung tiub fleksibel panjang iaitu endoskop. Kaedah ini biasa digunakan jika najis anda berwarna hitam atau anda muntah darah. Penggunaan kaedah ini membolehkan pemeriksaan bahagian esofagus, perut dan duodenum. Melalui kaedah ini, doktor pakar anda boleh menghentikan punca pendarahan.


Kolonoskopi - Kaedah ini digunakan untuk memeriksa bahagian dalam kolon dan rektum. Pemeriksaan ini dilakukan dengan menggunakan kolonskop, iaitu dengan mengunakan kamera kecil yang dipasang pada tiub fleksibel. Kaedah ini digunakan jika anda mengalami pendarahan bahagian bawah saluran gastrousus. Kolonoskopi membolehkan pemeriksaan dan rawatan bagi pendarahan dari usus besar.

Angiogram Mesenterik - Kaedah ini menggunakan kontras ataupun dipanggil dye dan disuntik ke dalam urat pesakit agar saluran darah boleh dilihat dalam pemeriksaan x-ray. Ini membolehkan doktor mengesan punca pendarahan dengan mengenal pasti lokasi saluran darah di mana dye itu aktif. Pendarahan ini boleh dikenal pasti semasa angiogram. Kaedah ini digunakan jika endoskopi dan kolonoskopi tidak dapat mengesan punca pendarahan atau tidak dapat menghentikan darah.

Endoskopi kapsul - Kaedah ini menglibatkan penggunaan kamera video menggunakan bateri sebesar kapsul. Alat ini digunakan untuk memeriksa usus kecil, bergerak mengikut pergerakan peristalsis. Teknik tidak invasif ini membolehkan doktor mengenal pasti punca pendarahan, terutamanya dalam usus kecil dan pesakit ini tidak perlu ubat penenang. Endoskopi kapsul hanya merupakan alat diagnosis. Pesakit masih perlu ujian selanjutnya untuk merawat pendarahan.

Enteroskopi - Kaedah ini membabitkan penggunaan skop optik yang panjang untuk memeriksa dan merawat bahagian usus kecil. Pemeriksaan usus kecil agak rumit dan membabitkan prosedur yang panjang. Dengan ini, kaedah ini tidak disyorkan oleh doktor pakar.

Cara Menghentikan Pendarahan

Suntikan - Untuk peptik ulser yang berdarah, adrenalin mungkin disuntik untuk menghentikan pendarahan dengan mengurangkan diameter arteri (vasokonstriksi). Kaedah ini murah, mudah dilakukan dan boleh didapati. Untuk pendarahan penyakit variks, suntikan histoacryl glu atau terapi ikatan atau ikatan variks adalah paling sesuai. Suntikan glu akan membolehkan glu menutup punca pendarahan.

Alat pemanas - Alat ini mengeluarkan haba dan tekanan secukupnya dan kemudian dikenakan ke atas saluran darah untuk melapik dan seterusnya menyebabkan darah membeku. Ini digunakan secara kombinasi dengan terapi suntikan. Kaedah ini sangat berkesan.


Hemoklip - Logam digunakan semasa endoskopi untuk menutup dua permukaan tanpa memerlukan pembedahan atau jahitan. Kaedah ini boleh digunakan untuk merawat pendarahan bahagian atas dan bahagian bawahan gastrousus dengan syaratnya punca pendarahan boleh dikenal pasti. Hemoklip ini digunakan jika saluran darah dapat dilihat. Klip logam ini adalah alat yang sangat berkesan untuk merawat atau menghentikan pemancutan darah.

Penggumpalan plasma argon (APC) - Arus elektrik frekuensi tinggi dialirkan melalui pancutan gas argon, yang boleh membeku darah bahagian yang luka. Kaedah ini bagus tetapi mahal dan belum didapati di sini.

Infusi perencat pam proton intravena - Perencat pam proton (PPI) merangkumi sekumpulan ubat yang menyekat pengeluaran asid gastrik. Infusi pam proton menurunkan pH persekitaran asid dalam perut. Dengan ini boleh membekukan darah dan mengurangkan perbelanjaan untuk pembedahan. Kaedah rawatan ini sering digunakan untuk merawat penyakit ulser dan dimulakan selepas terapi endoskopi.

Apa Yang Menyebabkan Pendarahan

Terdapat pelbagai keadaan yang boleh menyebabkan pendarahan dalam saluran penghadaman. Punca pendarahan di bahagian atas dan bahagian bawah saluran penghadaman termasuk:

Variks - Variks adalah saluran darah mengembang yang terdapat dalam esofagus atau perut. Ini akan berlaku apabila perjalanan darah ke hati terhalang. Darah ini kemudian mengundur naik ke dalam saluran darah yang lebih kecil dan lebih mudah pecah dalam esofagus. Ini menyebabkan saluran darah ini mengembang ataupun bengkak. Esofagus dan perut variks boleh pecah dan boleh mengancam nyawa. Biasanya komplikasi sirosis hati adalah masalah serius yang menyebabkan keadaan dan fungsi merosot secara perlahan-lahan dan mengakibatkan penyakit hati yang kronik.


Ulser peptik - Ulser peptik adalah hakisan dari duodenum atau lapik perut. Ini boleh menyebabkan pendarahan jika ulser itu dalam dan saluran darah terdedah. Pengambilan NSAID, aspirin dan jangkitan bakteria Helicobacter pylori adalah antara punca ulser peptik.

Dinding esofagus terkoyak - Ini disebabkan muntah atau menjeluak yang keterlaluan dan berulang-ulang. Dinding esofagus juga boleh koyak selepas serangan penyakit secara mengejut, batuk atau ketawa terlalu kuat, mengangkat benda berat, mengalami tekanan, melahirkan anak atau mengambil terlalu banyak alkohol.

Angiodisplasia - Ini adalah disebabkan saluran darah tidak normal dan saluran darah yang mengembang dalam gastrousus. Angiodisplasia banyak dikesan dalam pendarahan usus kecil dan boleh berlaku di mana-mana dalam saluran gastrousus. Pendarahan dari angiodisplasia mungkin, boleh menyebabkan anemia, atau pengaliran darah merah.

Kanser atau polip - Semua kanser gastrousus boleh menyebabkan pendarahan. Polip adalah ketumbuhan bukan kanser dalam saluran gastrousus, yang mungkin berdarah. Sesetengah polip boleh bertukar menjadi kanser.

Penyakit divertikulum - Ini adalah penyakit yang paling kerap. Ia tidak menyebabkan pendarahan merah dan banyak banyak. Pesakit mungkin akan pengsan kerana kehilangan banyak darah.


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